o.a.t.s--recovery/rehab

[mj/usa]

Hi!
I am facing an OATS procedure in September and would like to know how long can I expect to be out of commission---is how long before I am resonably mobile again? Is the pain level bearable??? Is the rehab very grim? or it is managable? My OS told me 6 weeks on crutches.
Again, any and all info is greatly appreciated.
Thanks

[Brad]

MJ,
I had the OATS procedure done a year ago. It was not as bad as I had expected it to be. I would give you a few words of advice. #1 very important DO NOT WALK (no weight at all) before you have been cleared. bone needs to heal first. #2 take it easy when you do start walking. #3 do not walk on concrete floors alot if it can be avoided. # 2 & 3 caused me to caused my graft not to take. I work a very physical job and I was walking all day on a concrete floor (up to 4 miles a day way more than OS said I could) Now I am now facing a Osteochondral Allograft. Therapy was not too bad until I started having problems at around three months. I pushed my self way too hard thinking the harder I pushed the sooner I would be 100%. I am now worse off. I know that my work conditions caused my graft to fail. I felt ready to run at around 12 weeks, and at about 14 I could barely walk up stairs. I was asked to do alot of things I was not supposed to do at work and did not let it heal. I think the OATS procedure is a great thing (if done right), but you are responsible to listen to your OS. Do the level he/she says. More does not = healed faster.
My last bit of advice is to strengthen your leg as much as possible before hand. It makes a huge difference.

Brad

[mj/usa]

Thanks Brad!

I intend to do exactly what my os says--I have great faith in him. The guy who did my first op (just a debridement and plica removal) was a real quack, so I feel lucky that I am now in good hands. I am much encourgaed by what you say and hope that all goes smoothly.
I am sorry for your misfortune and wish you good luck with the upcoming allograft.

mj

[Danielle]

What is this O.A.T.S. procedure?? I'm trying to do some research because OS mentioned OATS to my father for his knees and didn't say what it was. I am not familiar with it at all and it sounds AWFUL!!


~*~Danielle~*~

[mj/usa]

Danielle--

You can find a lot of info about oats on the kneeguru website. My op isn't until September, but from what I have read this is the only op that actually heals a cartilage defect--ie where there is actually ahole in the articular cartilage that lines the femur, also from what I understand it can only be done if the knee joint is otherwise healthy--no arthritis, no damage to ACL/PCL and meniscii. Theortically it sounds greats, I hope that it proves to be not too gruesome. I am going to try and get more info from my os next week.

[The_KNEEguru]

Here is the link to the relevant section of the KNEEguru main site:
http://www.kneeguru.co.uk/html/step_06_ ... kling.html

KNEEguru

[The_KNEEguru]

Just to put the procedure into brief context:

OATS is an abbreviation for 'osteo-articular transfer system'. It is a procedure which offers a chance of restoring damaged joint surface in the knee, where a big chunk of joint cartilage is damaged. As you know, joint cartilage does not heal itself when it is severely damaged. Rubbing it down to smooth it over (abrasion arthroplasty) may allow a little bit of healing, but the cartilage does not re-form fully - it makes a second grade form of joint surface which is called fibro-cartilage. Because true cartilage is much better, surgeons now are trying to replace damaged bits by taking a core (like a small apple core) of healthy cartilage (together with its underlying bone) from a less important area and punching it back into the damaged surface. The issues are:
1. Yes, sometimes the results are good, but there is the chance of it failing - in which case not only the original part is damaged, but also the donor part which had previously been healthy.
2. Some people heal well in the previously damaged area, and then have symptoms in the donor area.
3. The chunk must be taken with care and repositioned with care, as it has to fit snugly or it might come out, or ride proud (elevated).
4. New alternatives are being explored - to grow cartilage from the patient on scaffolds and then implant them into the area.
5. Only very experienced units are undertaking OATS procedures and it is still being evaluated.

[mj/usa]

Dear Kneeguru--

Thanks very much for your input---yours is an important voice to hear! I have been having a hard time finding critical opinions, or let us say, unbiased, opinions about oats. I was aware that sometimes the donor sites flare up, but since these are in non-weight bearing parts of the knee, and are therefore (at least as far as I can understand it) not subject to this kind of stress, how can they hurt???
My lesion is 15x7mm right snack dab in the middle of the medial femoral condyle and my os says that's why it's causing so much trouble. He says that since the rest of my knee is healthy (no arthritis, ligaments, etc ok) I am a great candidate for this type of surgery. You mention other alternatives, but other than carticel (which my os says in his experience does not od well overall) what is there????
Finally, my os is on your list and is at the hospital for special surgery here in NYC. I think that it anyone has a lot of experience with oats, this is the place. I hope I am right!!!

[Brad]

Here are some sites I had looked up before and after I had my surgery. It has some very good information. As hard as I tried, I could only find a little information on why this could fail. Most of the reasons for failure appear to be surgeon not putting the graft in properly or donor site problems. I think you will get a lot of information, some of them are very techincal. As I remember most sites show the sucess rate in the 80 to 90% at like 10 years. I hope this helps.

Brad

http://www.jointjuice.com/pdf/cartilagesubstitutes.pdf
http://www.drmendbone.com/carttran.htm
http://www.isakos.com/innovations/oats.html
http://www.kneeguru.co.uk/html/step_06_ ... kling.html
http://www.orthopodsurgeon.com/cartilage.html
http://www.stoneclinic.com/ocd/ocd.htm
http://www.aana.org/concepts/articles/o ... organ.html
http://www.medmedia.com/oo1/54.htm
http://www.maitrise-orthop.com/corpusma ... ndex.shtml
http://owl.orthogate.org/topics_knee.htm all kinds of knee topics
http://www.cartilagedoc.com/New/Video/KneePainCase.pdf
http://www.bioscience.org/1999/v4/d/fre ... lltext.htm

[The_KNEEguru]

Researchers are looking for other sites from which to 'harvest' the donor cartilage, such as the tibio-fibular joint (the joint between the shin bone and the thin bone on the outer side of the shin bone (research by Jerosch, Filler and Peuker (2000)).
Probably eventualy the new cartilage will be grown on a scaffold in the laboratory, using the patient's own cartilage cells.

[mj/usa]

Hi Brad!
Hi Kneeguru!

Thanks for the sites--there IS a lot of info out there and I will read it carefully. Next week I want to contact my os and ask him some more questions. I find it always difficult to ask the right questions when I have my appts so I try and write down what I want to ask and have forgotten (like brace or no brace afterwards, or cpm or no cpm post op). Armed with all this, I hope that I'll be able to organize myself well enough to get through the post-op period of no weight bearing. I am worried about the crutches and plan to practice starting beginning of September.
Anyway thanks again!

[PJP]

I was just wondering if anyone has had both and oats procedure and an meniscus allograft, because I'm having them both done soon. Also I would like to know whats the best way to recover (besides rest and exercise) and some of your experiences?

[martiniswiller]

Hi,
My OS is considering the OATS procedure, and I have done some research thanks to the kind post above with all the websites dedicated to this. I would like to know how this compares to the recovery of a Lateral Release- more or less painful? I have an appointment with my OS in 3 days, and I am trying to put together a list of questions for her, because of course the mind goes blank when it is time to ask questions. What do you feel are important questions to ask regarding this procedure besides recovery time, knee braces, and PT questions.
Thanks so much!

[martiniswiller]

I went to the OS today, and I am now scheduled for the OATS procedure in late september. She said 6 weeks no weight-bearing, and no PT or strengthening. I will also be put on a machine for 5 hours a day that does passive range-of-motion. Does anyone have any experience with these? Also, any tips and tricks to living your life w/no weightbearing on one leg would be greatly appreciated.
Thanks!

[mj/usa]

Hi!
I have no experiences to offer, but am facing the same oats operation on Sept. 16th...Perhaps we can trade experiences, misery loves company! My os also said no weight-bearing for 6 weeks and the cpm machine for about 3 hrs/day...
Good luck to you and please feel free to e-mail me at
[email protected]